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Results for “Hospital Restructuring”

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At least 1,189 records · Page 66Linked to original sources
PubMed1997

Managing the interface between medical schools, hospitals, and clinical research.

OBJECTIVE: To review how academic health centers are coping with the changing environment of health care delivery with special emphasis on the impact of the changing health care system on clinical research. DESIGN: In response to Health and Human Services Secretary Donna Shalala's 1995 mandated review of the National Institutes of Health (NIH) Warren Grant Magnuson Clinical Center, an NIH review team visited 30 health facilities and government-owned organizations throughout the country. The review team determined what strategies are used by academic health centers to survive and thrive in the changing health care marketplace. The findings have implications for the NIH Clinical Center as well as academic health centers. CONCLUSIONS: Management strategies in successful academic health centers include streamlined governance structures whereby small groups of highly empowered group leaders allow institutions to move quickly and decisively; an active strategic planning process; close integration of hospital and medical school management; heavy investment in information systems; and new structures for patient care delivery. Successful centers are initiating discussions with third-party payers and are implementing new initiatives, such as establishing their own managed care organizations, purchasing physician practices, or owning hospitals. Other approaches include establishing revenue-generating centers for clinical research and new relations with industry. Attention to the infrastructure required to support the training and conduct of clinical research is essential for the future vitality of medical schools.

Academic Medical Centers↗
PubMed1996

Common visions, shared goals: leadership in action.

A senior health care executive describes the strength of the Continuous Improvement philosophy in assisting senior and middle managers in transforming a children's hospital. Emphasizing the power of positive leadership in developing common goals and shared visions, and the relationship of midlevel managers to that process, examples are cited from a patient care delivery redesign project and in child advocacy.

Child↗
PubMed1995

The effects of hospital characteristics and radical organizational change on the relative standing of health care professions.

This paper examines the effects of hospital characteristics and radical organizational change on the relative representation of health care professions in hospitals over the period of the 1980s. Health care organizations, and hospitals in particular, represent organizations where multiple professional groups make competing claims of expertise that often conflict. The question our research seeks to answer is whether different constellations of organizational characteristics and organizational changes affect the outcome of these professional conflicts. Using the annual census of hospitals compiled by the American Hospital Association, we examine the effects of several characteristics of community hospitals on the relative representation of specific professional groups. We find that hospital mergers favor physicians at the expense of administrators, and multihospital system affiliation favors technical core occupations at the expense of administrators. Measures of organizational growth and decline increase the relative representation of physicians and administrators compared to nurses, and increase the probability that hospitals will employ physicians' assistants and nurse practitioners. Our results are evaluated in light of recent developments in the sociology of medicine and research on the relative standing of occupations in other industries.

Economic Competition↗
PubMed1997

The new VA.

Once the epitome of bloat, the Veterans Administration has slashed and slimmed its health care operations. The tactics mirror the marketplace: regional networks, consolidated purchasing, more outpatient care, capitation-like payment rates, and stiff performance targets. VA execs say it may actually work.

Efficiency, Organizational↗
PubMed1997

Achieving outcomes through organizational redesign.

The current health care environment demands delivery of high quality health services within increasingly restricted cost parameters. To meet these demands health care organizations are seeking performance improvement at every level within the organization. Delivering care is the core business of health care organizations. It is a complex process composed of multiple, interfacing processes and subprocesses. Successful redesign does not seek to make incremental improvement, but to create a new organizational framework in which processes enable achievement of quality, service, and cost outcomes. This article examines drivers for redesign, presents a process for redesigning health care organizations, describes successful management of organizational change, and presents a case study of a successful redesign initiative.

Communication↗
PubMed1997

Incidence of retinopathy of prematurity in Singapore.

The study was done to investigate the incidence and severity of retinopathy of prematurity (ROP) in Singapore over a one-year period. Its relation to factors like birth weight, gestational age are also explored so as to identify high risk groups and provide guidelines for the implementation of a screening programme in Singapore. At the various government restructured hospitals from Dec 1993 to Nov 1994, 34.4% (72 out of 209) of babies, with birth weights less than 1250 g or gestational ages less than 32 weeks, developed ROP. The incidence of ROP correlated significantly with low birth weight, early gestational age, multiple births; the severity correlated with low birth weight and multiple births. There was a notably higher proportion of Malays in the study population (premature babies) than all the live births of the same period. From the results, an optimal screening programme should include babies weighing less than 1250 g or of gestation earlier than 32 weeks. A first examination at 33 weeks of post-menstrual age is suggested.

Female↗
PubMed1997

Revolution or evolution in hospital management?

Hong Kong began to reform its public hospital administration in 1991. The development and implementation of policy, and the negotiation of a new management structure, are discussed below. Health professionals have been contracted as managers, and front-line carers have largely accepted the changes that have occurred. The evolutionary approach to reform which has been adopted may be preferable to the more drastic measures introduced in some other jurisdictions.

Cost Control↗
PubMed1997

[The rehabilitation of the psychiatric hospital. A question of audacity and synergy].

Using a mode of psychodynamic analysis, this article exposes some similarities between the factors that hinder the social reintegration of the "patient" and the social and political forces opposing the "rehabilitation" of the social institution represented by the psychiatric hospital. In support to this analogy, the article outlines the transformations realized over the last few years at the Centre hospitalier psychiatrique Sainte-Thérèse of Shawinigan and suggests that, in order to make such changes, the development of rehabilitation services can serve as a catalyst. The authors also propose a perceptual analysis of human, political and social reactions created by the metamorphosis of the traditional role attributed to the psychiatric hospital.

Attitude to Health↗